Breast Surgery

Breast Surgery

Whether you need a biopsy of a lump in the breast, removal of a benign mass, or treatment of breast cancer, Midland Surgical Associates has extensive experience treating a number of issues involving the breasts. These include:

Breast Biopsies

Percutaneous Core Needle Biopsy: This is an in-office procedure using ultrasound and local anesthesia to locate and then take cells from the breast mass with a special needle. The cells can then be viewed under a microscope to determine if cancer is present. If not, we will advise if the mass should be removed. If cancer is present, we will discuss your options, and you will also see an oncologist.

Excisional Biopsy: In this procedure, an entire lump or suspicious tissue is removed from the breast. The tissue is then studied to determine if cancer cells are present.

Benign Breast Disease

These breast problems are not related to cancer but may require treatment.

Benign Breast Masses: These benign masses include cysts or fibroadenomas (non-cancerous tumors that usually occur in girls and women under 30). In some cases, it is best to surgically remove them. They are usually biopsied first through a percutaneous core needle biopsy (see above) to determine if any cancer cells are present. If not, they can sometimes be left alone and monitored in future examinations.

Breast Abscess: This is an infection in the breast that may require antibiotics and possibly drainage.

Nipple Discharge: Nipple discharge is sometimes a normal function. If it is related to lesions in the breast, however, the lesions might have to be removed, which should resolve the discharge.

Breast Cancer Treatment

The treatment of Breast Cancer involves physicians and staff from multiple fields of medicine, including surgery, radiology, medical oncology, radiation oncology, and plastic surgery. The surgeon is closely involved with the patient, assisting in making referrals to physicians in other disciplines.

After reviewing the imaging studies and pathology reports, we work with you and your medical team to establish an individual treatment plan for you. When breast tissue is to be removed, we try to spare as much as we can.

Surgical Options include:

Breast Conservation Surgery (Lumpectomy and Radiation Therapy): In this case, the mass or area of concern is removed along with an area of normal tissue surrounding it. Since the majority of the breast does not have to be removed, this is typically an outpatient surgery. Radiation therapy is then required to decrease the chance of the tumor cells returning.

Mastectomy: Mastectomy involves the removal of the majority of the breast. Recovery is usually longer than with a lumpectomy with at least an overnight stay in the hospital. There are several types of mastectomy surgeries:

Simple/Total Mastectomy: The entire breast tissue is removed along with the nipple and areola.

Nipple Sparing Mastectomy: The breast tissue is removed, but the nipple and areola are left in place with a plan for immediate breast reconstruction by a plastic surgeon.

Modified Radical Mastectomy: In this case, the entire breast with the nipple and areola, as well as the lymph nodes under the arm, are removed.

Skin Sparing: With skin sparing surgery, the nipple and areola are removed while leaving as much skin intact as possible. This allows breast reconstruction to be completed at the same time as the mastectomy or soon after, often without the need of a tissue expander.

Lymph Nodes: Cancer cells from the breast usually travel first to the lymph nodes under the arm. As a result, the lymph nodes often need to be removed. The surgeries for removal include:

Sentinel Lymph Nodes: A select few lymph nodes are removed, known as sentinel lymph nodes. They are identified at the time of surgery using a small radioactive material and blue dye. The pathologist then tests these lymph nodes to see if there are any tumor cells present. This procedure can be done simultaneously with the breast operation, depending on the type of breast cancer.

Axillary Node Dissection: If there is any disease present in the lymph nodes, a patient may need to undergo an axillary node dissection. This is the removal of the majority of the lymph nodes under the arm.

Accelerated Partial Breast Brachytherapy

Some women who elect to undergo breast conservation surgery (lumpectomy and radiation) may qualify to have a balloon or multi-lumen catheter placed in the lumpectomy cavity.

This is done in our office after a lumpectomy, and the balloon is inflated with saline solution. The catheter is attached to a High Dose Rate machine (HDR) that inserts radiation into the breast. These radiation treatments are done for five days. After each treatment, the HDR is disconnected, but the catheter remains in place until the five-day radiation treatment plan is completed. This is a shorter span of radiation, which is preferable when the patient is a candidate for it.

BRCA Genetic Testing

About 5% to 10% of breast cancers are related to a genetic mutation. These are usually in families with a history of breast and ovarian cancer, especially when they occur at young ages (50 or younger). We provide in-office testing to determine whether a woman qualifies. A genetic mutation has an impact on the treatment and surveillance of breast cancer.

High Risk Breast Cancer Screening and Surveillance

Many women with a family history of breast cancer may be at increased risk for the development of breast cancer, such as those with the genetic mutation mentioned above. There are specific tests that can be done to calculate a woman’s risk for the development of breast cancer and to determine if she may benefit from additional surveillance. Screenings might include frequent mammograms and a breast MRI.

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